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Yes, the 2000 guidelines are outdated. They conceed that that the same pregnancy rate was achieved by transferring significantly fewer blastocyst stage embryos, thus significantly reducing the incidence of twins, triplets, etc.
Blastocyst transfers did not provide any direct benefit to specific patient populations. Blastocyst transfer is not a panacea. O.K.
BUT It does give a much greater amount of information to the RE and the patient about the cause of their infertility. Most embryos look at least passible on Day 3. So they are transferred. When it doesn't work, no one knows why. So, the patients steps up to the plate and pays for another cycle. When that doesn't work, and there is still no good answer for the failure, it is chalked up to the "luck of the draw". "It doesn't work ever time. Be patient." "Try again." And on, and on, and on.
When blastocyst transfer is attempted and only a few of the embryos reach the blastocyst stage, or, in the worst case senario none of embryos reach the blastocyst stage, the answer is clear. There is a serious problem with the embryos. If the cycle is unsuccessful, time to move on. No mystery, no second mortgage.
If several embryos form blastocysts with good developmental potential and no pregnancy results, then its time to look elsewhere such as endometrial developmet or immunological problems, etc. No time wasted on two or three unsuccessful cycles, no second mortgage.
In addition to reducing high order multiple gestations, blastocyst culture and transfer provides additional DIAGNOSTIC information about the underlying cause of the couple's infertility and allows for a more informed decision about the next step of treatment, should the IVF cycle fail.
Sooooo, knowing this, why would the ASRM conclude that there is insuficient evidence to prefer blastocyst transfer. They chose not to look at one of the most obvious benefits - information.
Of course, the insurance folks are incapable of reading between the lines, so this whole point is completely lost on them. Remember, they are in the business of collecting premiums, not paying claims. Yes, there is an extra charge for extended culture of the embryos to the blastocyst stage. However, if it reduced the number of failed IVF cycles they had to pay for.... Duh.
There's something you should know. Insurance companies have bean counters deciding on what is cost effective and what is not. A failed IVF cycle costs the insurance company less than a sucessful one. That's because obstetrical care and the new baby will cost them more at the same preium price. Hmm. Go figure (pun intended).
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